Continuous Glucose Monitors (CGM)
Medi-Cal Rx Benefit Update
Continuous Glucose Monitors (CGM)
Effective, January 1, 2022: New or expired TAR requests for Therapeutic CGM (DexCom or Libre) are now the responsibility of Medi-Cal Rx and ordering providers should no longer submit TAR requests for K0553 or K0554 to CenCal Health. Please submit Prior Authorization (PA) for the therapeutic CGM product directly to Medi-Cal Rx.
In an effort to minimize member and provider disruption, existing, active TAR requests for K0553 and K0554 will be honored by CenCal Health through June 30, 2022.
After June 30, 2022 a new Prior Authorization (PA) submission to Medi-Cal Rx will be required for coverage consideration.
For inquires regarding an existing CGM CenCal Health TAR please contact CenCal Health Medical Management: (805) 562-1082.
For inquires regarding Medi-Cal Rx Prior Authorization process and/or CGM criteria please contact Medi-Cal Rx: 1-(805) 977-2273 or visit https://medi-calrx.dhcs.ca.gov/home/
CenCal Health Pharmacy Department is also available to assist with any Medi-Cal Rx inquires at: (805) 562-1080
Medi-Cal Rx 2022
Medi-Cal Rx Support Services
The following document will provide the processing information for Medi-Cal Rx (i.e. BIN, PCN & Group) and additional payer information.
Medi-Cal Rx Support Services and Key Payer Sheet Details
Pharmacies requesting additional operational claims support please contact:
Medi-Cal Rx Customer Service Center at: (800) 977-2273
Pharmacy Network & Covered Drug List